The first fatality of Madagascar’s deadly plague outbreak – which has now claimed at least 74 lives – initially went unnoticed.

In late August, according to researchers with the World Health Organization (WHO), a 31-year-old man was visiting the island’s central highlands when he developed what appeared to be the symptoms of malaria.

A few days later, travelling on one of the island’s crowded taxi-brousses (minibus taxis) en route to Tamatave – a journey that took him via the capital, Antananarivo – the unnamed man’s condition worsened, and he died.

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No one realised he had been infected by the plague, and his body was prepared for burial without precautions.

In the space of a few days, 31 people who had come into contact with him – either directly or indirectly – were infected. Four of them subsequently died.

Since that first “case zero”, the outbreak of the highly contagious strain of plague has claimed 74 lives over two months, infecting more than 800 people.

Marking the outbreak as doubly dangerous, many cases have also featured the most virulent form of what was known in the Middle Ages as the Black Death – pneumonic plague.

It is initially caused when advanced bubonic plague spreads to the lungs: this slower acting and relatively less contagious form of the disease attacks the patient’s lymphatic system. Pneumonic plague spreads very easily and is deadly if untreated.